本文選題：肺功能　切入點(diǎn)：呼吸中樞驅(qū)動(dòng)　出處：《廣州醫(yī)學(xué)院》2011年碩士論文

【摘要】：第一部分肺功能與呼吸中樞驅(qū)動(dòng) 目的肺功能隨年齡的增高而不斷地下降。老年人肺功能下降是因?yàn)楹粑袠序?qū)動(dòng)下降還是肺結(jié)構(gòu)的改變尚不清楚。這一研究用多導(dǎo)食道電極記錄的膈肌肌電評(píng)價(jià)健康青年及老年人的最大呼吸中樞驅(qū)動(dòng)及靜息狀態(tài)下的呼吸中樞驅(qū)動(dòng),探討健康老年肺功能下降與呼吸中樞驅(qū)動(dòng)變化的關(guān)系。 方法隨機(jī)選擇8例健康老年人(57.3±5.0歲)及8例性別匹配的健康青年人(28.3±3.4歲),檢測(cè)其肺功能,并通過(guò)多導(dǎo)食道電極記錄膈肌肌電反映呼吸中樞驅(qū)動(dòng)。觀察靜息狀態(tài)下及最大用力吸氣時(shí)的膈肌肌電。 結(jié)果老年組的肺活量(VC)3.21±0.51(L)顯著低于青年組(4.0±0.84 L, P0.05 );老年人最大努力吸氣動(dòng)作時(shí)的膈肌肌電與青年人相似(172.2±54.6μV vs 175.0±55.7μV, P=0.921)。老年人安靜狀態(tài)下的潮氣量及每分通氣量與青年人相似,但其呼吸中樞驅(qū)動(dòng)占最大值的百分?jǐn)?shù)顯著高于青年人(27.8%±12.9% vs 16.4%±7.2%, P0.05)。老年人呼吸中樞驅(qū)動(dòng)有效性比青年人小一倍(62.7%±23.2% vs 128.6%±96.2%). 結(jié)論老年人的呼吸中樞驅(qū)動(dòng)儲(chǔ)備低于青年人;肺功能隨年齡減退并不是因?yàn)楹粑袠序?qū)動(dòng)下降,而是因?yàn)榉谓Y(jié)構(gòu)改變所致。 第二部分健康青老年人運(yùn)動(dòng)時(shí)呼吸中樞驅(qū)動(dòng)及其有效性的變化 目的本研究通過(guò)多導(dǎo)食道電極記錄的膈肌肌電評(píng)價(jià)健康青年及老年人在遞增踏車(chē)運(yùn)動(dòng)過(guò)程中的呼吸中樞驅(qū)動(dòng),探討健康老年人呼吸中樞驅(qū)動(dòng)及其有效性是否與青年人不同。 方法隨機(jī)選擇9例健康老年人(59.3±7.8歲)及9例性別匹配的健康青年人(27.6±3.0歲),通過(guò)多導(dǎo)食道電極、食道囊分別記錄老年和青年在遞增運(yùn)動(dòng)過(guò)程中的膈肌肌電、食道壓、通氣及氧耗等,以膈肌肌電作為反映呼吸中樞驅(qū)動(dòng)的指標(biāo)。 結(jié)果受試者在靜息狀態(tài)下重復(fù)多次最大努力吸氣動(dòng)作,老年組的食道壓(62.4±17.4 cmH_20)小于青年組的食道壓(79.5±8.1 cmH_20),有統(tǒng)計(jì)學(xué)差異(P0.05);兩組受試者在整個(gè)實(shí)驗(yàn)過(guò)程中所獲得的最大膈肌肌電相似(218.2±54.3μV vs 220.2±48.6μV, P=0.935)。在運(yùn)動(dòng)過(guò)程中,兩組EMGdi%max(%)均隨運(yùn)動(dòng)負(fù)荷的增加而逐漸增大,直至運(yùn)動(dòng)末兩組的呼吸中樞驅(qū)動(dòng)均顯著低于最大值,且運(yùn)動(dòng)結(jié)束時(shí)老年組EMGdi%max(%)為64.9%±7.8%,高于青年組55.7%±8.9% ,有統(tǒng)計(jì)學(xué)差異(P0.05)。運(yùn)動(dòng)末老年組的呼吸中樞驅(qū)動(dòng)有效性差于青年組(101.1%±18.8% vs 158.9%±35.7%, P0.01)。 結(jié)論多導(dǎo)食道電極記錄的膈肌肌電可以準(zhǔn)確地評(píng)價(jià)正常人在運(yùn)動(dòng)狀態(tài)的呼吸中樞驅(qū)動(dòng);兩組受試者運(yùn)動(dòng)末呼吸中樞驅(qū)動(dòng)均未達(dá)到最大值,提示健康人存在呼吸中樞抑制以避免呼吸肌疲勞;老年人肺功能變差所致的運(yùn)動(dòng)末呼吸中樞驅(qū)動(dòng)高于青年人,是造成老年人運(yùn)動(dòng)耐量差于青年人的其中一個(gè)因素;呼吸中樞驅(qū)動(dòng)及其有效性差于青年人,與老年肺功能變差有關(guān)。呼吸中樞驅(qū)動(dòng)有效性可能是反映肺通氣效率的有效指標(biāo)。
[Abstract]:Part I Pulmonary function and respiratory central driveObjective Pulmonary function decreases with age.It is unclear whether the decline in lung function in the elderly is due to decreased respiratory center drive or changes in lung structure.In this study, the diaphragm electromyography recorded by multichannel esophageal electrode was used to evaluate the maximal respiratory center drive and resting respiratory center drive in healthy young and old people, and to explore the relationship between lung function decline and respiratory center drive changes in healthy elderly people.Methods the pulmonary function of 8 healthy elderly patients (57.3 鹵5.0 years old) and 8 healthy young people (28.3 鹵3.4 years old) were measured, and the diaphragm electromyography was recorded by multichannel esophageal electrode to reflect the respiratory center drive.The diaphragm myoelectric activity was observed at rest and maximum inspiratory force.Results the vital capacity of the elderly group was 3.21 鹵0.51L) significantly lower than that of the young group (4.0 鹵0.84L, P0.05), and the diaphragmatic myoelectric activity of the elderly was similar to that of the young people (172.2 鹵54.6 渭 V vs 175.0 鹵55.7 渭 V, P0. 921).The tidal volume and ventilation volume per minute in the elderly were similar to those in the young people, but the percentage of respiratory center drive in the maximum value was significantly higher than that in the young people (27.8% 鹵12.9% vs 16.4% 鹵7.2%, P0.05%).The effectiveness of respiratory drive in the elderly was twice as high as that in the young (62.7% 鹵23.2% vs 128.6% 鹵96.2C).Conclusion the respiratory central drive reserve of the elderly is lower than that of the young, and the decline of lung function with age is not due to the decrease of respiratory drive, but to the change of lung structure.The second part: changes of respiratory center drive and its effectiveness during exercise in healthy young and aged peopleObjective to evaluate the respiratory center drive of healthy young people and old people in the process of increasing treadmill exercise by means of diaphragm electromyography recorded by multichannel esophagus electrode, and to explore whether the respiratory center drive and its effectiveness in healthy old people are different from those in young people.Methods A total of 9 healthy elderly patients (59.3 鹵7.8 years old) and 9 sex-matched healthy young people (27.6 鹵3.0 years old) were randomly selected. The diaphragm myoelectric activity and esophageal pressure were recorded by multichannel esophageal electrode and esophageal sac in elderly and young people during progressive exercise.Ventilation and oxygen consumption were measured by diaphragm electromyography.Results the subjects repeated their best efforts to inhale several times in the resting state.The esophageal pressure (62.4 鹵17.4 cmH20) in the elderly group was lower than that in the young group (79.5 鹵8.1 cmH20), there was significant difference between the two groups (P 0.05), and the maximal diaphragm electromyography obtained in the two groups was similar to 218.2 鹵54.3 渭 V vs 220.2 鹵48.6 渭 V, P0.935.At the end of exercise, the respiratory center drive of the two groups was significantly lower than the maximum value, and at the end of the exercise, the EMGdimax value was 64.9% 鹵7.8%, which was higher than that of the young group (55.7% 鹵8.9%). There was a significant difference between the two groups (P 0.05).The efficacy of respiratory drive in the elderly group at the end of exercise was significantly lower than that in the young group (101.1% 鹵18.8% vs 158.9% 鹵35.7g, P 0.01).Conclusion the diaphragm electromyography recorded by multichannel esophagus electrode can accurately evaluate the respiratory central drive of normal subjects in the state of movement, and neither of the two groups has reached the maximum value at the end of exercise.It is suggested that respiratory center inhibition exists in healthy people to avoid respiratory muscle fatigue, and that the respiratory center drive at the end of exercise due to the deterioration of lung function in the elderly is higher than that in young people, which is one of the factors contributing to the poor exercise tolerance of the elderly compared with young people.Respiratory center drive and its effectiveness were lower than that of young people, which was related to the deterioration of lung function in the elderly.Respiratory center drive effectiveness may be an effective indicator of pulmonary ventilation efficiency.
【學(xué)位授予單位】：廣州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R332

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